Barriers and facilitators to the accessibility of maternal healthcare services in rural Southeast Asia: a systematic review
Rui-Kyi Ng, Rui Shi Ng, Qian Qian Charmaine Tan, Wan Ting Beh, Suei Nee Wong, Carl Grundy-WarrObjectives
To identify the key barriers and facilitators affecting access to maternal healthcare services in rural Southeast Asia (SEA).
Design
Systematic review.
Data sources
PubMed, Scopus, Embase, CINAHL and PsycINFO were searched for studies published between 1 January 2000 and 25 February 2025.
Eligibility criteria
Studies were included if they were conducted in rural regions of SEA, examined access to maternal healthcare services and were published in English.
Data extraction and synthesis
Two reviewers independently screened studies, extracted data and assessed the risk of bias using the Mixed Methods Appraisal Tool. Quantitative findings were transformed into textual descriptions and synthesised with qualitative findings using thematic analysis. Themes were mapped onto Levesque’s framework across demand and supply-side dimensions of healthcare access.
Results
A total of 9673 records were screened, with 52 studies (27 quantitative, 21 qualitative and 4 mixed methods) meeting the inclusion criteria for analysis. Key barriers to seeking care included limited awareness of services, cultural preferences for traditional birth practices and language barriers. Financial burden, geographic distance and inadequate transport infrastructure were barriers to reaching care. Key facilitators included family support, perceived importance of maternal and child safety, trust in healthcare providers and family involvement in decision-making. Culturally sensitive care, community outreach and health promotion efforts were key in improving women’s ability to use maternal health services
Conclusions
This review highlights the complex and multifaceted challenges in maternal healthcare access in rural SEA. Addressing financial, geographical and sociocultural barriers is crucial for improving access to maternal healthcare, especially in underserved and rural regions. Limitations include restriction to English language studies, study heterogeneity and limited grey literature representation. Future interventions should adopt a holistic, community-based approach to foster an integrated and effective health system.
PROSPERO registration number
CRD420261305602.